originally puublished as a chapter in Jeffrey Cram's book Clinical Surface EMG Volume 2.

EMG self awareness and control techniques can be used to train individuals to increase awareness and voluntary control of their emotional states, volitionally facilitating positive feelings, attitudes and expectancies.

Our muscles not only move us through our world, they also mediate our experiencing of it.

This chapter describes how conventional relaxation biofeedback, and zygomaticus biofeedback training paradigms can be readily integraed into an emotional self regulation model for optimizing the individual's capacity and ability to make the most of positive experience opportunities and to maximize positive affect and attitude.

Biobehavioral patients (Pain, stress, anxiety, somatic dysfunction, phobia, behaviorally exacerbated medical illness) tend to tighten muscles, constrict their peripheral vasculature and emotional response range, and narrow and rigidify their selective perceptual pattern of viewing their environment so they often miss or less-than-optimally respond to positive opportunities. After they've learned relaxation and stress regulation techniques they are still in need of emotional expression skills so they can make the most of opportunities for positive experience.

The ability to express emotion effectively, to be aware of feelings before one acts, and to perceive the emotional expressions of others has helped humans to survive the Darwinian evolutional selection process of the survival of the fittest. The Neanderthal who could sense and control his fear so he didn't scream, saved his family from detection. The warm and affectionate Cro Magnon man was more likely to connect with a mate and keep her with him so he could father several children-- thus perpetuating his genes. The Peking man with a sense of humor could laugh his way out of an argument.

Emotions: The Same Language All Over The World

Our feelings are connected to our faces. When we make faces, we activate a universal human response programmed into our bodies before birth. Charles Darwin wrote in his 1872 book, The Expression Of The Emotions In Man And Animals, that emotions are not learned, but rather, biologically determined. About 100 years later, research psychologists Paul Ekman and Carrol Izard independently travelled around the world to observe the faces people make to express different emotions. In every culture, every country they studied, they found that people smiled to express happiness, scowled when feeling angry, and made the same faces to express fear, disgust, and other basic emotions. This universal set of facial expressions strongly suggests that the most common emotional expressions are not learned, like the hundreds of spoken languages, but rather, are wired into our nervous systems. We smile or frown because the facial expressions are programmed, through our genes, into our being. The dog's bark and cat's meow, the shocked look of surprise, the sneer of disgust and the happy smile are woven into the spiral helix of the DNA that spells out the definition and specifications of each species.

Just as hair and skin color, height and nose shape are passed along from parent to child, many of the facial muscles and other body parts that express emotion are also hereditarily influenced, giving some people blinding smiles, with flashing gums. or distorted attempts at smiles which produce barely perceptible movements at the corners of the mouth.

Emotional Illiteracy

Emotional expression starts at birth with crying and takes many weeks or months to begin blooming. Parents lovingly work to cultivate those first smiles, coos and laughs. Long before the child can deevelops language skills, he can cry, scream or smile anything out of Mama or Papa. Once walking and talking begin, our culture shifts all the emphasis there, almost forgetting emotional communication skills entirely. Emotional expression training tapers off, with few if any conscious efforts at the emotional equivalent of grammar training or vocabulary building or further development of the language of emotions. We're left to fend for ourselves.

Over 100 years ago a debate on one of the most important aspects of human emotion began. What comes first? Does something which happens in our environment, like the screeching of tires, set off a racing heart beat so we feel the pounding in the chest and become aware of the emotion? Or do we hear the tires, feel the fear and become fearful, thus setting the heart racing?

Pioneer psychologist, William James, took this position in the debate, " An emotion of fear, for example, or surprise, is not a direct effect of these objects's presence on the mind, but an effect of that still easier effect, the bodily commotion which the object suddenly excites; so that, were this bodily commotion suppressed, we should not so much feel fear as call the situation fearful; we should not feel surprise.., but coldly recognize that the object was indeed astonishing. ...the mere giving way to tears, for example, or to the outward expression of an anger-fit, will result for the moment in making the inner grief or anger more acutely felt."

James' following observation spells out the heart of the pattern activation component of the Happiness Response model of emotional self regulation. "...Action seems to follow feeling, but really action and feeling go together; and by regulating the action, which is under the more direct control of the will, we can indirectly regulate the feeling, which is not. ...Thus the sovereign voluntary path to cheerfulness, if our spontaneous cheerfulness be lost, is to sit up cheerfully, to look round cheerfully, and to act and speak as if cheerfulness were already there. If such conduct does not make you soon feel cheerful, nothing else on that occasion can.

"So to feel brave, act as if we were brave, use all our will to that end. .... and a courage-fit will very likely replace the fit of fear. ...To feel kindly toward a person to whom we have been inimical, the only way is more or less deliberately to smile, to make sympathetic inquiries, and to force ourselves to say genial things. ...One hearty laugh together will bring enemies into a closer communion of heart than hours spent on both sides in inward wrestling with the mental demon of uncharitable feeling. ...To wrestle with a bad feeling only pins our attention on it, and keeps it still fastened in the mind; whereas, if we act as if from some better feeling, the old bad feeling soon folds its tent ... and silently steals away."

The debate is still alive, but more researchers have, like James, now take the position that both sides can be true.

Making Faces Can Increase Body Muscle Strength

Several researchers have proved that grimacing actually increases hand strength. Making a face produces a direct effect on a seemingly un-related part of the body. Just as grimacing intensifies grip strength, making strong facial expressions can intensify experience of other emotions.

Recent computerized assessment of multiple site Facial EMG activity has demonstrated its superiority over observer visual assessment of subject's emotions.

During the past 10 years many studies have repeatedly shown high correlations between facial muscle activity and emotional state. Fair and Schwartz reported that normals show stronger zygomatic response during positive affective imagery. Depressed patients exhibit stronger corrugator responses and weaker zygomatic responses. This seems analogous to the pattern physical therapists encounter when using biofeedback to rehabilitate weakened or atrophied muscles. One muscle (like the zygomaticus) is underactive. The antagonist muscle (the corrugator) is overactive and must be voluntarily inhibited and controlled.

We have been using Zygomaticus activation and Corrugator muscle inhibition EMG feedback for positive affect facilitation, intensification and "smile rehabilitation. Prospective data is being collected. When subjects are instructed to maximally activate the zygomaticus, readings range from 12 microvolts (100-200 hz bandpass) to 150 microvolts. Practice appears to dramatically increase contraction strength above initial levels. When subjects are induced to laugh or smile naturally, their EMG activity tends to be higher than during volitional efforts at maximal zygomatic contraction, or even maximal efforts to smile.

This suggests an inhibitory process at work, perhaps similar to what occurs during the early stages of thermal biofeedback training, when efforts to produce vasodilation usually result in cooling of the fingers. Further zygomaticus increase training, coupled with biofeedback monitored smiling and laughing to facilitate subject "connectedness" with the awareness of psychophysiological dimensions of positive emotion seems to lead to the ability to equal and then exceed automatic or "involuntary" positive emotional response EMG activation.

Caccioppo mentions one Japanese study in which a group of human cadavers were dissected and two percent of them were found to be lacking their zygomaticus-- the primary smile muscle. Were they atrophied through lack of use or missing from birth.

Emotion researcher Sylvan Tomkins suggests that most people rarely express pure, uninhibited emotions. They transform, inhibit and modify feelings based on their acculturation. The feelings end up being blocked and are never really felt. Tomkins suggests that breathing and vocalization are the most strongly blocked. The facial muscles are used to prevent the feelings from being expressed. Instead of jumping and shouting joyously, we smile with drawn cheeks and pursed lips. We need to be able to control our emotional displays in some situations. The problem is, some people don't learn how to modulate the release of uninhibited emotional expression. They are either totally inhibiting or totally emoting. Raw emotional expression can be frightening, like an "alien force within" if it is only released on rare occasions-- during intoxication or under extreme circumstances. For feelings to be tamed, one must be capable of varying mixtures of voluntary and uninhibited control. One has to be able to modulate emotional letting go-- ten percent sometimes, ninety five percent other times. Practice can help.

If a positive experience opportunity presents itself, one must be able to quickly make the most of it by connecting with it as completely as possible yet appropriate, emotionally, mentally and physically. It takes training and practice to learn how to comfortably express and experience deep feelings.

I often ask seminar participants to smile at the very beginning of my presentation. A few don't smile at all. Some scowl. Some barely smile, and some let loose with strong smiles at the least excuse. I only allow about three seconds and then I say, "Stop. If you didn't smile yet, you lost your chance." A quick, strong positive experience reflex is necessary to get the most out of each minute.

We are conditioned to experience good feelings in response to the smile and warm, happy sounds, since most of the time, smiles and happy or pleasure sounds and actions are genuine parts of positive experiences which produce good feelings.

Paul Ekman told professional actors and actresses to make emotional faces, one muscle group at a time. This way, the instructions didn't cue the actors to the kind of face formed. They weren't told to make a happy or frightened face, but rather, to move their facial muscles in specified patterns, ie.; pull the brows together, pull the mouth back horizontally, raise the upper eyelids, etcetera. Ekman found that different facial expressions produced different physiological response patterns. Just combining facial muscle activity patterns could produce predictable heart rate and hand temperature increases or decreases. Synthetic faces seemed to illumine the whole body with emotion-appropriate patterns of physiological activities.

Paralysis of Feeling

If synthetic faces can turn on feelings, paralyzed faces can turn off feelings. Psychologist Ben Twerski, co-author of a chapter in a book on paralysis, discussed how facial muscle paralysis patients suffered more depression than other paralysis patients. In a conversation, we speculated, that perhaps, their facial muscles weren't stimulating and exercising the conditioned feeling responses, the patterns that are turned on in the brain and which the brain activates when people make happy faces.

In one study, military veterans with spinal cord injuries reported decreased experience of emotion after their injury. The more extensive the spinal cord damage and resultant greater loss of body sensation, the greater was their loss of their ability to feel emotion. Patients described their feelings as cold, as mental rather than feeling and emotional.

"But I can't make a fake smile." so many people respond when asked to turn on a fake or synthetic smile. I tell them to do it anyway! The goal of emotional self regulation is to teach individuals to learn to find their own buttons for activating the patterns of good feelings built into their nervous system. The other side of the coin is the need to identify how they inhibit good feelings. I explain to patients, that when we create a synthetic smile, we usually experience feelings that flicker between the real; "feeling-good" and; "I'm just faking this and I feel silly or stupid" feelings. The reason we can actually switch to feeling genuinely good just by creating a synthetic smile is response pattern activation. The activation of facial muscle patterns usually genuinely associated with good feelings actually facilitates the turning on of the real thing--a feeling-good, conditioned response.

New patients often resist instructions to smile. They resist, saying: "I can't smile," "I don't want to smile," "It feels silly," or "strange" or "It doesn't feel real so I don't want to do it."

I ask one to smile and he says he can't. I pause, allowing the silence to grow pregnant, then nod my head with a whimsical smile and ask, "C,mon. You can't smile?" I knit my brow, perplexed. "Do you have a neurological deficit? No? Then you don't want to smile?" My patients appear annoyed, as though they were about to say, "Leave me alone. I don't want to smile." But they do want to smile. My little pre-schooler acts the same way when he's miffed. I joke with him and he flickers between laughing, smirking and frowning. The patients are stuck in old patterns of inhibition that prevent them from opening up to good feelings when they want to.

It's so common for people to be uncomfortable expressing their feelings. John Perry describes how anorgasmic women are comfortable having orgasms masturbating with their legs closed, but become anxious when they spread their legs. He teaches them to masturbate with their legs spread so they become comfortable with the position.

Here's how I work with smile resisting patients: I suggest, "You do want to smile, don't you? Let me show you how." At that point, I demonstrate an exagerated smile. Or I'll tell a joke or threaten tickling (if it's a group.) So far, this effort has never failed. Every patient smiles and usually laughs spontaneously. Part of the reason my little trick works is because there are two nerve pathways which control the smile and other facial expressions. The upper nerve pathway is connected to the gray matter motor cortex of our brain. When we decide we want to smile and think "smile," then the motor cortex activates our smile via the upper nerve pathway. Stroke patients with damage to their motor cortex lose the ability to voluntarily turn on a smile, though some smile rehabilitation physical therapy can help. But even after a stroke, patients with the lower smile pathway still intact will reflexively smile in response to something funny or ticklish, because the lower pathway is connected to the lower part of the brain, where emotions are mediated and where the stress and emotion mediating sympathetic nervous system is controlled. I get my patients to smile and laugh by bypassing their voluntarily or subconsciously disconnected upper smile pathway. I've tickled their lower smile pathway into activation by turning on synthetic smiles that activate the PE physiological response pattern, allowing them to feel the real thing.

The smile response pattern activation proves to my patient he can smile. When he sees my exagerated, smile, an image of a smile is formed in his brain. This smile image helps to animate or rouse his own smile-conditioned response pattern homunculus and to facilitate the lower pathway smile response pattern. The image functions like a template or behavioral "mold," shaping and helping the release of his feeling-good response, even though the patient had been stuck, inhibiting it a moment earlier.

Some patients are feeling so bad, they say they don't want to or can't smile. Then, smile biofeedback can be useful. Patients use zygomaticus EMG feedback to tell them what strategies help to boost their smile muscle strength and boost the EMG amplitude.

They learn to voluntarily create a genuine smile that helps them let go of their positive experience inhibiting behaviors. The concrete, muscle strength oriented feedback helps them to strengthen their smile reflex without initially expecting wonderful feelings. Over and over again, we've found in our research that people, when asked to smile as strong as they can, work and strain to make a smile. Sometimes, in their beginning efforts to intensify their smiles, they screw their faces into distorted smiles, very artificial in appearance (just as other physical therapy patients suffer from unwanted co-contraction of antagonist muscles). We crack some jokes, kid around. Making any feeling good sound, like laughter, humming, cheering, seems to strengthen the smile activity. When we coax them into laughing, the smile comes effortlessly with the help of the lower motor neuron pathway, and is 20% to 100% stronger than the strained effort. This approach actually teaches feeling relaxation-- the ability to stay relaxed and comfortable while feeling deep emotions.

Kicking in the lower motor-neuron pathway is a very important step for the so many people suffering from alexithymia and other emotional dysregulation disorders. Learning to at first tolerate, then remain comfortable while experiencing strong feelings is often a sign of improvement for patients in many different forms of psychotherapy. The anxiety of feeling emotion is a common one that can be coped with very effectively. The feeling biofeedback and facial muscle exercises allow people to take small, safe steps. The patient's begin to take risks. The smile becomes more symmetrical, more natural and more robust. The goal of smile aided relaxation is to go beyond feeling nothing, to feeling deeply, to be able to comfortably enjoy strong, deep feelings. You can learn to turn on the full range of your emotions with comfort and joy.

Smile Anatomy

The most basic smile muscle is the zygomaticus, named after the zygomatic arch-- the cheek bone-- which it attaches to at one end. The other end of the zygomaticus attaches to the corner of your mouth.

Activation of the Zygomaticus

Try exercising your zygomaticus now. Pull the corner of your mouth towards your cheek. Palpate for the zygomaticus. Smile and tighten or contract the zygomaticus. Then relax it, so you can feel the muscle moving under your facial skin. Put your index finger near your cheek and your pinky near the corner of your mouth and contract your zygomaticus. Use all four of your fingers to feel along the muscle. Relax and then tighten the muscle so you can feel around your cheek to find the most activity. Try a little smile, then full faced, beaming grin. Feel your zygomaticus bulge as your smile intensifies. Palpate along your cheekbone then down towards your mouth until you find the most activity. Focus on the sensations in your skin as you smile.

Because of genetic variation, some people will have bigger zygomaticus muscles than others. Some zygomaticus muscles will be built up more around the front of their cheek while in others, the zygomaticus is further back on the cheek bone. Though there's little research, it makes sense that humanity's genetics has included smiles in its approach to biological diversity. There may be people who were born with easier, bigger, wider smiles. There may be people with more smile inhibition nerve paths. I instruct patients to get to know their zygomaticus, the most important and central of the smile muscles. The other smile muscles act as modifiers, adjective-like descriptors and smile flavoring components.

The eye muscles involved in smiling, the lower lateral orbicularis Oculi pars palpabraeus, which crinkle up our lower eyelids and produce crow's feet, seem solidly connected with lighthearted, open-hearted good feelings and warmth. The eye smile muscles can work with the levator labii superioris-- upper toothy smile muscles-- to intensify the total smile. These lift the upper lip to show the teeth, and are connected to the orbicularis oculi pars palpabraeous eye smile muscles. Try making a little smile, then add your heart and turn the smile into a strong, genuine, high intensity smile, including your eyes.

Darwin suggested that the levator muscles might be involved and that at the least, they were attached to the orbicularis oculi muscles and they either aided in the lifting of the upper lip when the oculi muscles were involved or at least, acted as cables, pulling up the upper lip through the activation of the eye smile muscles. Paul Fair, when a graduate student at Harvard, found that the lower outer portion is the only part of the ring of muscle encircling the eye that is significantly involved in smiling. I instruct clients to practice smiling with just the lower outer part of their orbicularis oculi, to be careful that they don't frown or just squeeze the entire eye muscle when they attempt to activate the key part of the muscle.

Ekman reports that not everyone appears to be able to voluntarily control the lower orbicularis oculi muscle. His observation concurs with our own findings. Yet we've seen that with biofeedback aided training people can usually learn to develop voluntary control of these muscles. It may be that learning to turn on smiling eyes is like learning to warm the hands. You can get good at the skill without being able to verbalize what you are doing.

It seems that smiling with the eyes makes it easier to connect with, and smile with and from the heart. The eye smile muscles become involved in more intense, intimate and open smiling. Barriers seem to melt when two people face each other eye to eye and smile a full faced smile with puffed lower eyelids and gleaming, squinted eyes. Darwin speculated squeezing the eyeball caused a change in its shape which produced the sparkle so often associated with smiling, cheerful eyes.

There may be some muscle activity involved. besides the zygomaticus in raising the upper lip. The levator superioris muscle is definitely involved in the look of disdain, and may be involved in lifting the upper lip in some strong smiles. Ducchenne actually separately categorized the zygomaticus into two parts, one to raise the corners of the mouth and the other raising the upper lip. But many facial anatomy charts omit the zygomaticus minor.

Some people, particularly people who wore braces, are shy about showing their upper teeth. They inhibit or minimize the activity of the muscles that raise the upper lip. Experiment with adding lifting your upper lip to your smile. Pay attention to the different parts of your upper lip and how your feelings vary as you activate them.

Showing the upper teeth in a smile appears to always be accompanied by zygomaticus activity. But what happens if a person is shy or nervous and inhibits the major ingredient in his or her smile. If he inhibits the zygomatic ''primary'' smile activity but allows the ''secondary smile activity'' upper lip to be raised, or pulls his lips straight back rather than up towards the zygomatic arch, he may turn on a "nerdy" kind of grin like the Nerds in the Nerds movies, "Seymour" in The Little Shop of Horrors or Jerry Lewis in his earlier comedies. Or the zygomatic activity may be replaced with a pursed lipped, forced smile produced by the buccinator and risorius or platysma.

Emotional Expression Anatomy

It can be very useful to go beyond the smile ABC's to develop a smile vocabulary so you can clearly discuss with patients and help them to think precisely about what they do when they smile. The more they can understand the physiological activities and events that underlie the smile and positive experiences, the better thry'll be able to control and enjoy them. The list of muscles and the facial muscle anatomy chart below are provided to help your patients connect with the pieces of their emotional expression tool kit. Even if one is already in perfect emotional health, the smile anatomy information can still be used to identify smile patterns and ways one can strengthen less active components.

Experiment with and try to identify each muscle's activity on your face. Tense or flex it a little, then a lot. Combine two or more smile muscles. What expressions, if any, do these produce on your face? What feelings do you experience?

The birth of Electrophysiology

The descriptions of the muscles are taken from my own observations, those of the many researchers I've interviewed and reviewed the literature of, and the work of Duchenne, an 18th century french physiologist. In the 1830's through 1870's, Duchenne used a Faraday battery (similar to the kind Ben Franklin used for his famous key-in-a-kite experiment.) to stimulate the muscles of cadavers and live subjects so he could observe the electrophysiology of motion. He observed the actions of the muscles to determine where they were attached and how they functioned. It's unlikely the same research could be performed now. He warns of the risk of burned out eyeballs in these experiments. The more anachronistic descriptions are Duchenne's.

muscle of benevolence and frank joy. causes crow's feet, twinkling in the eye.

3-Nasalis-lewdness and lasciviousness, flares nostril creases central part of nose. I call it the Q spot because it was labeled Q on Duchenne's facial anatomy chart and because, like the "G spot", it has the potential to turn on sexual arousal.

2-palpebralis superior and inferior, muscle of contempt and complementary muscle of weeping.

3-labii superioris moderate weeping or grief, whimpering. This muscle lifts the upper lip. It seems to act as an intensifier for many feelings.

4-orbicularis oculi. The muscle encircling the eye.

5-Masseter- may go slack during fear

6-triangularis- muscle of sadness-- pulls down corners of mouth

7-corrugator- muscle of anguish, pulls eyebrows in and down towards nose

8-Buccinator- muscle of irony-- a deeper muscle that pulls the mouth straight back

9-platysma- a large sheet of muscle that attaches at the corners of the mouth, pulling down

This is just a partial list. The dozens of facial anatomy maps I've examined illustrate the facial musculature differently, many omitting minor muscles or calling them by different names.

Have patients Use your mirror or touch your face with your fingers and feel how each muscle moves and feels as you flex it with different amounts of tension.

Subliminal Smile Rehabilitation

Cancer patient counselor Yvonne White, takes an indirect approach when working with depressed or angry patients who don't want to smile. She assigns them exercises using muscles that are less obviously associated with the smile, like the platysma and mentalis muscles. She reports patients come back asking, "Are you trying to trick me into smiling? Because it's working."

Remember, facial muscles are but one category in the expression and experiencing of feelings. Posture, tone of voice, energy availability, previous activity all play important roles in what we feel and how we turn on our feelings.

Progressive Smile Activation

This is a great exercise to do in a group, but is also useful to practice on a regular basis to build your smile reflex speed and strength.

Begin by turning on your zygomaticus. Pump a little zygomaticus iron for a few repetitions. Relax a few moments. Next, Start with activating your zygomaticus and add your lateral inferior (outer lower eye) orbicularis oculi and smile with eye eyes, making them twinkle. Pump this a few times. Next, start with the zygomaticus and eye-smile activation and add lower mouth, showing your teeth smiling. You can just add Mentalis and next Platysma, or take a short cut and do them together. Next, use your levator superioris to raise your upper lip and show your upper teeth. Make sure during all of this that you are not squeezing the rest of your eyes or corrugator or any muscles that have not been specified. Next, pull your head back, like you do when you really laugh. Next, breath from your abdomen. Next, move your arms and move your body from side to side. Add laughter or silly sounds and let yourself really loosen up enough to get silly and playful. You may want to experiment with tightening only one side of a pair of muscles. Try adding the nasalis and naris muscles-- flare your nostrils and scrunch up your nose. Remember, Duchenne suggested that was the muscle of lust and lasciviousness. See what feelings you experience when you use these muscles. Look at the activity in the mirror. What does it look like to you? Even better, do this exercise looking at someone else who does the exercise with you. This exercise was inspired by the work of Colorado Psychiatrist Christian Hegaseth, author of The Laughing Place.

Self Administered Smile Nerve Blocks

In case after case, depressed, angry and stressed patients have appeared to be creating their own upper smile pathway nerve block. Camille Palumbo, a counselor at Jefferson Medical Univ. calls this smile psychomotor retardation. Paul Fair, an Atlanta psychologist treated facial paralysis patients at Emory Univ. He found that the first thing he had to teach these patients was deep relaxation, so they could control the sometimes bizarre grimaces they would produce while attempting to smile. (I've often seen similar grimaces in normal, non-paralyzed people.) The facial paralysis patients would come in for two hour treatment sessions three times a week for several months. They were very motivated, and even small results helped them to feel much better about themselves and their appearances.

If you take just a little time to practice strengthening your smile reflex, you'll be helping yourself in several ways. First, you'll be better prepared to quickly smile into connecting with PE opportunities that present themselves to you. Second, you'll begin to develop a smiling face as your resting muscle tone for your face. Third, at a pre-conscious level, you'll begin processing and filtering your experiences with a better attitude that your smiling face sets up reverberating throughout your body.

Patients can practice smile exercises almost anywhere. I usually combine them with my aerobic workout and my exercises on weight machines and Nautilus equipment, when I'm driving and when I shave in front of a mirror. I recommend they try to "pump smile iron" at least three times a day, doing sets of six muscle tensings. If you don't see immediate results, and most people do, persevere. Remember the flicker factor and relax to allow good feelings to pop in as a conditioned response.